SHM Converge Scientific Abstract ePoster Gallery-An Atypical Presentation: West Nile Encephalitis Imitating as Vestibular Neuritis, Unfolding Into Guillain Barre Syndrome

An Atypical Presentation: West Nile Encephalitis Imitating as Vestibular Neuritis, Unfolding Into Guillain Barre Syndrome

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This case report describes an atypical and severe presentation of West Nile virus (WNV) infection in a 73-year-old man. He initially presented with vertigo, headache, tinnitus, and vomiting, which mimicked vestibular neuritis. Despite initially normal imaging, his condition rapidly worsened with fever, confusion, and respiratory failure requiring ICU admission and intubation. Cerebrospinal fluid studies showed inflammatory changes, and WNV IgG was detected, supporting neuroinvasive WNV encephalitis.<br /><br />On hospital day 20, he developed progressive bilateral leg weakness with absent reflexes, reduced tone, and impaired proprioception, while upper extremity strength remained intact. MRI of the spine demonstrated enhancement of the ventral cauda equina nerve roots, consistent with Guillain-Barré syndrome (GBS). He was treated with intravenous immunoglobulin (IVIG) and improved, eventually requiring inpatient rehabilitation.<br /><br />The report emphasizes that WNV can range from asymptomatic infection to severe neuroinvasive disease, with older age and comorbidities increasing risk. Although GBS is a rare complication of WNV, clinicians should consider it when neurological deficits evolve after WNV infection. The case highlights the diagnostic challenge posed by early nonspecific symptoms and the importance of close monitoring, especially during mosquito season. Early recognition and timely testing may improve outcomes and reduce morbidity.

Asset Subtitle

Kanza Maqsood

Meta Tag

Author List Anjum Dhamani, Diego La Torre, Kanza Maqsood, Kishan Talagadadeevi, Sabita Ale Thapa

Category Clinical Vignettes

Concept West Nile Virus Infection

Concept Neuroinvasive Disease

Concept Guillain-Barré Syndrome

Concept Encephalopathy

Concept Weakness

Distinguished Non-Finalist

Presenter Organization Texas Health Resources HEB/Denton Internal Medicine Residency

Presenting Author Kanza Maqsood

Track Adult

Keywords

West Nile virus

WNV encephalitis

Guillain-Barré syndrome

neuroinvasive infection

vertigo

respiratory failure

cerebrospinal fluid

intravenous immunoglobulin

cauda equina nerve roots

mosquito season

West Nile Virus Infection

Neuroinvasive Disease

Guillain-Barré Syndrome

Encephalopathy

Weakness